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Radiation therapy for glioblastoma: Executive summary of an American Society for Radiation Oncology Evidence-Based Clinical Practice Guideline
- Source :
- Practical radiation oncology. 6(4)
- Publication Year :
- 2016
-
Abstract
- Purpose To present evidence-based guidelines for radiation therapy in treating glioblastoma not arising from the brainstem. Methods and materials The American Society for Radiation Oncology (ASTRO) convened the Glioblastoma Guideline Panel to perform a systematic literature review investigating the following: (1) Is radiation therapy indicated after biopsy/resection of glioblastoma and how does systemic therapy modify its effects? (2) What is the optimal dose-fractionation schedule for external beam radiation therapy after biopsy/resection of glioblastoma and how might treatment vary based on pretreatment characteristics such as age or performance status? (3) What are ideal target volumes for curative-intent external beam radiation therapy of glioblastoma? (4) What is the role of reirradiation among glioblastoma patients whose disease recurs following completion of standard first-line therapy? Guideline recommendations were created using predefined consensus-building methodology supported by ASTRO-approved tools for grading evidence quality and recommendation strength. Results Following biopsy or resection, glioblastoma patients with reasonable performance status up to 70 years of age should receive conventionally fractionated radiation therapy (eg, 60 Gy in 2-Gy fractions) with concurrent and adjuvant temozolomide. Routine addition of bevacizumab to this regimen is not recommended. Elderly patients (≥70 years of age) with reasonable performance status should receive hypofractionated radiation therapy (eg, 40 Gy in 2.66-Gy fractions); preliminary evidence may support adding concurrent and adjuvant temozolomide to this regimen. Partial brain irradiation is the standard paradigm for radiation delivery. A variety of acceptable strategies exist for target volume definition, generally involving 2 phases (primary and boost volumes) or 1 phase (single volume). For recurrent glioblastoma, focal reirradiation can be considered in younger patients with good performance status. Conclusions Radiation therapy occupies an integral role in treating glioblastoma. Whether and how radiation therapy should be applied depends on characteristics specific to tumor and patient, including age and performance status.
- Subjects :
- Oncology
Male
medicine.medical_specialty
Hypofractionated Radiation Therapy
Bevacizumab
medicine.medical_treatment
Guidelines as Topic
03 medical and health sciences
0302 clinical medicine
Internal medicine
medicine
Humans
Radiology, Nuclear Medicine and imaging
Prospective Studies
Temozolomide
Performance status
business.industry
Brain Neoplasms
Dose fractionation
Guideline
United States
Surgery
Radiation therapy
Regimen
030220 oncology & carcinogenesis
Dose Fractionation, Radiation
business
Glioblastoma
030217 neurology & neurosurgery
medicine.drug
Subjects
Details
- ISSN :
- 18798519
- Volume :
- 6
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Practical radiation oncology
- Accession number :
- edsair.doi.dedup.....f17d264202661b77ca7a0cc4f6562a1d